What are some factors that lead to medication non-adherence for people with serious mental illness?

Medication adherence refers to the extent that medication intake corresponds to recommendations of the healthcare provider. Medication non-adherence may look like failing to initially fill or refill a prescription, discontinuing a medication before completing the course of therapy, taking more or less of a medication than prescribed, or taking a dose at the wrong time. Individual factors associated with medication non-adherence include low education level, young age, cognitive impairments, paranoia, substance use, minority ethnicity, poor insight, low socioeconomic status, poor therapeutic alliance, and other barriers to treatment such as prior experience with treatment. The potential consequences of medication non-adherence among someone with serious mental illness include exacerbation of their illness and complications which lead to re-hospitalization, poor psychosocial outcomes, relapse of symptoms, reduced effectiveness of subsequent treatment, increased substance use, poor quality of life, and increased risk for suicide.

There are both intentional and unintentional reasons that clients do not take their medications as prescribed. Intentional reasons include active decision making such as weighing pros and cons, possible concern for side effects, and stigma associated with needing or taking certain medications. Appropriate interventions for intentional medication non-adherence include open communication with provider for educating and informating, addressing concerns, and assisting client in making informed decisions regarding their treatment. Unintentional reasons for medication non-adherence include passive involvement in treatment, forgetfulness or trouble taking medications at appropriate times, and not knowing how to use the medications. Appropriate interventions for unintentional medication non-adherence include simplifying the regiment, providing reminders, and other support.


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